2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
junostomy was created using a combined linear stapled and
handsewn technique. Three patients were converted to open
procedure (0.6%). There were 500 females and 20 males. Mean
age was 40 years (range 18-65) and mean preoperative body
mass index was 46.4 kg/m2 (range 36-68). Mean follow-up for
all patients was 11 months and mean excess weight loss at 18
months was 70%. None of the patients presented stomal
stenosis postoperatively. Eleven (2.1%) were diagnosed with
marginal ulceration by upper endoscopy. Stomal stenosis is an
infrequent complication following retrocolic-retrogastric
laparoscopic Roux-en-Y gastric bypass with combined linear
stapled and handsewn gastrojejunostomy. A reduction in Roux
limb tension with the retrocolic-retrogastric approach may play
a role in reducing the incidence of this complication.
P230–Complications of Surgery
LATE GASTRIC PERFORATIONS AFTER LAPAROSCOPIC FUN-
DOPLICATION, K L Huguet MD, T Berland,R A Hinder, Mayo
Clinic Jacksonville
Introduction: Late complications are rarely encountered after
laparoscopic Nissen fundoplication (LNF). We report a series of
delayed gastric perforations complicating LNF and review the
potential etiologies.
Methods: In the authors? series of 1600 laparoscopic antireflux
procedures performed between July 1991 and March 2002, we
report a new finding of six delayed gastric fundal perforations
in three patients 1, 41, 48, 51, 60, and 64 months after surgery.
All had been taking celecoxib.
Patient # 1: 71 yo WM presented 3 years after LNF with pneumoperitoneum
while on celecoxib. Exploratory laparotomy
revealed a gastric perforation on the gastric fundus, which was
oversewn. Several months later the patient again presented
with pneumoperitoneum and exploratory laparotomy revealed
a gastric perforation at the same site, which was oversewn.
Patient # 2: 58 yo WF presented 1 month after LNF with pneumoperitoneum
while on celecoxib. Exploratory laparotomy
revealed a gastric perforation on the anterior surface of the
fundus. This was oversewn without complications.
Patient #3: 67 yo WM presented 4 years after a LNF with pneumoperitoneum
while on celecoxib. Exploratory laparotomy
revealed no source. One year later the patient again presented
with pneumoperitoneum and exploratory laparotomy revealed
a gastric perforation on the anterior surface of the fundoplication,
which was oversewn. Several months later the patient
again presented with pneumoperitoneum. He recovered well
after percutaneous aspiration and medical management.
All patients had minimal peritoneal contamination leading to
the conservative management of patient # 3.
Conclusion: This series of late gastric fundal perforations in
0.2% of patients after laparoscopic fundoplication could potentially
have been caused by celecoxib, gastric stasis, ischemia,
or foreign body such as a stitch or pledget. Patients after
laparoscopic fundoplication should be advised to avoid the use
of non-steroidal anti-inflammatory drugs, which may cause
acute gastric ulceration with perforation.
P231–Complications of Surgery
PANCREATIC COMPLICATIONS AFTER LAPAROSCOPIC
SPLENECTOMY, Kotaro Kitani MD, Masataka Ikeda
PhD,Mitsugu Sekimoto PhD,Masayuki Ohue PhD,Hirofumi
Yamamoto PhD,Masakazu Ikenaga PhD,Ichiro Takemasa
PhD,Shuji Takiguchi MD,Masayoshi Yasui MD,Taishi Hata
MD,Tatsushi Shingai MD,Morito Monden PhD, Department of
Surgery and Clinical Oncology, Graduate School of Medicine,
Osaka University
Background: Laparoscopic splenectomy (LS) has been accepted
as a standard operational procedure for hematological diseases.
Pancreatic complication is one of major complications
associated with this procedure. We reviewed pancreatic complications
following LS to find out the incidence of pancreatic
injury and its impact on postoperative management.
Methods: Case log analysis of hospital charts were reviewed.
85 patients in a variety of hematological disorders underwent
LS (including Hand-Assisted LS) between May 1996 and March
2004. We selected to perform Hand-Assisted LS (HALS) for
186 http://www.sages.org/
patients with splenomegaly. We measured postoperative
serum amylase level (S-AMY) and amylase concentration of
peritoneal fluid (D-AMY). Pancreatic fistula was defined as
infected drainage with high D-AMY
Results: Two patients (2.4%) had pancreatic fistula and one
patient had concomitant pancreatitis. Their D-AMY was
extremely high level (66600 and 4458 IU/L), while their S-AMY
was almost within normal range (91 and 171). Their surgical
drains were removed on 15 and 8 postoperative days, respectively.
For the rest of other patients, drains were removed
within three days of operation. In the first patient, HALS was
employed, and operative time was 245 and 315 minutes, blood
loss was 100 and 120ml, resected splenic weight was 2315 and
1100g, respectively. Fifteen patients (20%) had asymptomatic
hyperamylasemia, and recovered uneventfully. Eleven patients
(11%) developed high D-AMY level without any symptoms.
Mean splenic weight of these patients was 654g and statistical
analysis showed a significant relationship between D-AMY and
resected splenic weight.
Conclusions: We report two cases of postoperative pancreatic
fistula which required long drainage. Patients with
splenomegaly need special attention for postoperative pancreatic
complications.
P232–Complications of Surgery
PORTAL VEIN THROMBOSIS AFTER LAPAROSCOPIC
SPLENECTOMY FOR SYSTEMIC MASTOCYTOSIS, Majed
Maalouf MD, Daniel Gagné MD,Pavlos Papasavas MD,David
Goitein MD,Philip Caushaj MD, The Western Pennsylvania
Hospital, Temple University Medical School Clinical Campus
Laparoscopic splenectomy has become the surgical technique
of choice for various diseases of the spleen. Portal vein thrombosis
(PVT) following splenectomy occurs in 0.5-22% of
patients. Symptoms are non-specific and include fever,
abdominal pain, and epigastric distress. Risk factors for PVT
following splenectomy include underlying hematological disorders,
massive splenomegaly (>1kg), thrombocytosis (>106)
and other hypercoagulable states.
We describe a case of PVT in a woman who underwent laparoscopic
splenectomy for symptomatic splenomegaly secondary
to systemic mastocytosis. The patient was discharged from the
hospital without anticoagulation and experienced nonspecific
symptoms beginning 10 days postoperatively. Diagnosis of
PVT was made by contrast enhanced abdominal computed
tomography. The patient had no underlying risk factors.
Anticoagulation treatment facilitated recanalization of the portal
vein and this was verified by Doppler ultrasound at followup.
PVT following laparoscopic splenectomy is not uncommon.
Signs and symptoms are vague and require a high index of
suspicion for timely diagnosis. Anticoagulation is the treatment
of choice and allows recanalization of the portal system
in the majority of cases.
P233–Complications of Surgery
DOES LAPAROSCOPIC APPENDECTOMY INCREASE THE RISK
OF INTRAABDOMINAL ABSCESS, J M Saxe MD, D Tong MD,K
Kralovich, Henry Ford Hospital
The laparoscopic approach to appendectomy has been gaining
in popularity. Some reports have indicated however an
increased incidence of post operative abscess formation in
complex appendicitis treated by laparoscopy.
Recommendations have favored open procedures when
abscess was known preoperatively. Perforation and infected
fluid is not always able to be determined preoperatively. Our
hypothesis is that postoperative intra-abdominal abscess formation
is not higher after laparoscopic appendectomy when
compared to open appendectomy for appendicitis.
Methods: A retrospective study of all patients who underwent
an appendectomy at our single institution between January
2002 and March 2003. Exclusion criteria included patients
under 18 years of age and incidental appendectomy. Charts
were reviewed for age, gender, intraoperative diagnosis, operative
procedure, postoperative complications, and length of
stay. Operations were classified as laparoscopic(LA), lap. converted
to open (CO), and open appendectomy (OA). Diagnosis
was classified as normal, acute appendicitis, gangrenous and